In the United States, 1 in 9 babies is born prematurely, 1 in 10 in Canada. Worldwide, over 15 million babies are born too soon each year. While not all multiples are born prematurely, a multiple birth increases the probability of an early delivery. Babies born prematurely, before 37 weeks gestation, are at a higher risk for health complications in infancy, some of which can have long-term effects. Full-term infants are not all free from their own health complications, of course.
In honor of November’s Prematurity Awareness Month, led by the March of Dimes, How Do You Do It? is focusing this week’s posts on The Moms’ experiences with premature deliveries, NICU stays, health complications, special needs, and how we’ve dealt with these complex issues.
Despite the reams I’ve written about motherhood over the years, I’ve never sat down to write my daughters’ birth story in its entirety. When they were newborn, I was too busy and it was too raw and painful. Later, every time I thought about blogging about it, I chose not to, fearing that I would frighten expectant mothers with my horror story. I just said, “They were born by emergency C-section at 33 weeks,” and left it at that.
It’s not a horror story, though. In the end, my daughters are okay. They’re fantastic. They’re happy, healthy and whole; funny, sassy and smart; loving, considerate and goofy. Sure, I have my scars, but I have never felt the grief of losing a child or the very different grief that a child’s special needs will limit her options in life. It could have been so much harder.
I had a remarkably uneventful pregnancy, especially considering that I was carrying identical twins. I was tired, of course, and ate enough to feed a small family. I was eating for a small family, come to think of it. Other than that, though, I felt great. I had no morning sickness. I threw up once, but it was because the tap water in our new house was nasty. I did start having pretty severe Braxton Hicks contractions around 30 weeks, made worse if I allowed myself to get dehydrated.
My mother-in-law threw us a baby shower in Oregon, but my doctor strongly recommended that I not travel past about 25 weeks, so I stayed in Texas. At 31 weeks, my obstetrician recommended that I stop working the following week. In my great wisdom, I instead elected to work half-time, working from home 3 days a week and coming into the office twice.
My husband and I took our Lamaze class early, with other expectant moms two months closer than we to their due date, but I still never really considered the reality of the chances of our girls being born early. After all, the triplets in our family were born at 38 weeks! In fact, while I’d made my packing list and assembled the girls’ cribs by 30 weeks into the pregnancy, I didn’t pack right away and didn’t think anything of my soldier husband leaving for a week-long field problem in the wilds of Ft Hood when I was 32 weeks along.
The Babies Are Coming!
My husband returned home from his wilderness field problem, delighted to trade in his sleeping bag for our bed. My pregnancy was at 33 weeks. He was exhausted from having been in the field and I was exhausted from growing babies, so we went to bed early.
At 1:22 am, I was woken up by a cold wetness in my bed. I instantly knew that my water had broken. Later, I learned that only J’s water had broken. My babies were mono-di; their shared chorion had ruptured, as had J’s amniotic sac, but M’s amnion was still intact.
I woke my husband. He started mumbling about car seats and I realized that I was going to need to take control of the situation.
“It’s too early,” I told him, more calmly than I felt. “They won’t come home with us. We need to get to the hospital. Bring the insurance stuff and some books for me to read. You can come home for everything else.”
We called our doctor, who told me to use a maxi pad to catch the constant leak between my legs. On the drive to the hospital, I called my mother-in-law. She immediately started looking into airplane tickets to fly from Washington state to Texas.
The First Hospital
We had preregistered at our local hospital, so I went right into the maternity ward. The nurses took my maxi pad away to test it. While we waited, I changed into a hospital gown and my contractions started. After what seemed like an unnecessarily long time, a nurse returned to inform us of what we already knew. It was amniotic fluid and I was in labour.
The doctor on call at our suburban hospital told me that he was going to recommend that I be transferred to another hospital, Brackenridge in Austin. At the time, it was connected to our local Children’s Hospital and the best NICU around. Even though Brack wasn’t part of the hospital network we’d arrived at, our ob used to have privileges at Brackenridge and pulled strings to get an ambulance to transport us across hospital networks. There was no chance of the natural vaginal birth I’d hoped for. Both babies were breech.
“I would rather these babies arrive at the NICU inside you than after birth,” I remember the on-call doctor saying. “You also want to recover from your C-section in the same hospital they’re at so you can see them.” I wish I remembered his name. He was so kind.
My labour was progressing much too fast. My contractions were hard and fast but I was hardly dilated. While they arranged for the ambulance, they started me on a magnesium sulfate drip to slow my contractions. They also inserted a urinary catheter. They asked me if I’d be okay with a trainee nurse performed that procedure with an experienced nurse overseeing her. I agreed. I’m fully supportive of educational opportunities, but it did hurt.
When the ambulance was ready and the paperwork done, everything happened very fast. I was rolled out into the ambulance bay on my bed, and tried to yell directions to Brack to my husband when I realized he’d be driving behind us. My impressions of the ambulance were of bright lights, sirens, bumps, increasingly painful contractions and a kind nurse with warm hands who tried to distract me from my contractions with questions about my hopes for my daughters.
Getting Settled at the Second Hospital
I later learned that my husband got lost on his way to the hospital. He called his mom in Seattle to get online and find him directions in Austin, Texas. She still marvels at the wonders of technology that early morning of May 10, 2006.
The on-call doctor came in and introduced himself, telling me that I was going to have an emergency C-section. I asked if there was any way to just deliver Baby A and leave Baby B in to gestate longer. He just said no and asked for me to start getting prepped for surgery.
The nurses checked how I was doing. They reported high protein in my urine and became alarmed. There was a rush of activity and a nurse came to see whether I had dilated any farther than my last measly 1 cm, reported at the first hospital. She went silent and I got scared.
“Um, where did you get catheterized?” she asked.
“At [the first hospital],” I told her.
“Well, they put the catheter in your vagina, not your urethra. You’ve got some serious bladder control, girl!”
They removed the catheter from my vagina. It hurt, far more than my full-bladder contractions. Once they got everything in the right place, the contractions became almost comfortable. I later learned that I’d been at risk of bladder rupture, thanks to the first hospital’s mistake.
They started my epidural. I’d be going under the knife awake, my lower body numbed. I was started to worry that my husband wouldn’t arrive on time.
He arrived just as I was being rolled into the operating room. I confess that I was too scared to notice much of what was going on. There were people in scrubs everywhere. They threw up a curtain across my body and strapped down my wrists. I remember thinking, “No, this isn’t supposed to be how they enter the world. This is all wrong.”
The doctor asked if I could feel anything below my waist. I could feel him pressing, I told him. He started to cut. Fortunately, all I felt was pressure. I was scared, but my husband was holding my hand. He was fascinated by what he saw on the other side of the curtain.
“J’s here,” he told me suddenly. I heard something that sounded like a kitten meowing. Her Apgar score was 9. I saw a flash of black hair and she was gone to the NICU. My husband was holding my hand again.
Splash. My husband guffawed.
“They punctured M’s sac and she splashed all over the doctor. That’s my girl,” he said proudly.
I heard more meowing, drowned by a delivery nurse’s urgent whisper. “There’s something wrong with her face!”
Her Apgar score was 8. One wrist was unstrapped so I could stroke her hair and then she was gone. I urged my husband to follow her to the NICU, but he reminded me of our agreement to let him stay with my until I was sewn back up. As soon as the last staple was in, he disappeared.
The First Day
I lay in my recovery room. It was 6:45 am and I was a mother who couldn’t do a thing to parent her own children. I waited until 8:00 and called my coworker Dustin to tell him that I wouldn’t be at our morning meeting… or any meetings at all for a while. I later learned that he took the brunt of our female coworkers’ wrath, since I failed to give him the girls’ birth statistics and he failed to ask.
A nurse came into check on me and deliver a hospital breast pump. She told me that my husband had been very forceful in his insistence that I be given every opportunity to breastfeed. I looked at the pump equipment and figured out how it fit together. I started pumping, as I would do every 3 hours without fail for the next weeks that my daughters were in the NICU.
I began to regret having told my husband to stay with the babies. I wanted to know how they were doing. The recovery nurse promised to ask. Soon, our friends Kaylan and Markus arrived. Kaylan was horrified that I hadn’t seen any photos of the babies yet. She marched off to the NICU and returned with two photos on her phone.
Our concerns for M’s health are a matter for another post. I was running a fever, so I couldn’t see the babies. When my husband came into my room to see me, he noticed me cradling my belly. I was feeling the lack of sensation (which wouldn’t return for months) but he was concerned for my mental health.
“You had the babies,” he told me. “They’re not in there any more.”
“I know!” I told him, but I’m not sure he believed me.
All I could do was pump. I pumped and pumped and pumped and nothing came. I remembered a coworker telling me that his wife’s milk never came in. Their (now perfectly healthy) daughter was born so early that mom’s body interpreted the birth as a stillbirth, not a live birth. I felt like a useless hunk of meat.
My mother-in-law arrived and asked me to call my therapist. I did, and we had a session over the phone. I felt a lot better after talking through all my irrational feelings of failure at my daughters’ premature arrival.
The Second Day
My colostrum came in. I got a tiny golden drop on the side of each of two preemie bottles. I paged the nurse and asked the woman who arrived to please take the bottles to the NICU.
She picked up the bottles and turned them in the sunlight. “You want me to take this to them?” she asked incredulously.
“No,” I snapped, my dams breaking and the tears beginning to pour. “I don’t want you to take that. Give them back.”
The nurse supervisor heard me sobbing and came in to see what was going on. I told her between my sobs that I’d finally done something good for my babies, some act of actual motherhood, by producing colostrum and felt judged by the nurse for not having more. She comforted me, saying that I was right, that colostrum was liquid gold and every speck would help my babies. She would walk the colostrum over to the NICU herself. They would pour formula into the bottles to make sure that every last bit made it into my children. I should keep pumping and she would make sure I got a visit from the lactation consultant.
I’d seen photos and been warned, but the NICU was overwhelming. My sense of smell was still working overtime as it had while I was pregnant. The pain from my incision when I stood from the wheelchair to scrub into the NICU mixed with the smell of the soap. I still can’t visit that hospital network and smell that soap without feeling the twinge in my uterus and heart. It’s been over 7 years.
The beeps of the machines seemed too loud and I panicked when I realized that I didn’t know which babies were mine. My husband wheeled my over and parked me between their open isolettes. I wanted to know why they weren’t being cobedded. I was told that hospital policy had recently changed and multiples were no longer allowed to share an isolette in the NICU.
I tried to hide my irritation and fear by asking about what the all the machines, wires and tubes did. The nurse surprised me by lifting M into my arms. I had no idea that I was going to be allowed to hold her. She was so small. I was reminded again of a kitten, although I confess thinking that she and her sister both looked like a cross between a lizard and a monkey. Her face and ears were still furry with lanugo. I could see where her eyebrows began only because they were was a thin line of hairlessness outlining their upper edges.
It wasn’t long before I learned that my daughters were doing exceptionally well, despite their gestational age and despite their 3 lb 6 oz and 3 lb 9 oz birth weights. They were “feeder-growers,” in the NICU only to eat and grow. Since they were born before their baby fat developed, they needed help maintaining their body temperatures outside the womb. Since they were born when they should still be nourished through the umbilical cord, feeding was a challenge. Other than size and feeding, they were perfect… apart from whatever might be wrong with M’s nose.
My own recovery was much slower and more painful than I anticipated. In my eagerness to visit the NICU, I kept tearing my staples out and reopening my incision. That too, I think, is a story for another time.
Sadia (rhymes with Nadia) has been coordinating How Do You Do It? since late 2012. She is the divorced mother of 7-year-old monozygotic twins, M and J. She lives with them and their 3 cats in the Austin, TX suburbs and works full time as a business analyst. She retired her personal blog, Double the Fun, when the girls entered elementary school and also blogs at Adoption.com and Multicultural Mothering.